Saturday, 12 November 2011

Naomi the Welsh

This was one of the most entertaining tours of duty I've had in a long time. My Welsh paramedic joined me so that she could compare her job to ours, out here in the frontline battlefield that is London. Her name is Naomi and she's been a paramedic for only a short time. Her shifts consist of a few calls and a lot of time driving from one place of 'cover' to the next. Her patient-bound journeys can take up to an hour and the hospital runs are just as long. The LAS? Well, our patient journeys are about 1 to 10 minutes on average and our hospital runs tend to be in the same ballpark. However, we pay for this with many, many more calls, a hell of a lot more abuse and a great deal of risk and violence.

So, a fainting rough sleeper in a train station, whose medical history included five heart bypasses, started us off but we were joined by the ambulance crew at the same time, so neither of us laid a hand on the patient.

This was quickly followed by a police call to a young woman who was fitting in a shop. Armed cops had come across her and had rendered some basic aid whilst waiting for our arrival. Again, the crew was on scene very quickly too, so it was a minimal challenge for us. I spoke to the patient's mother on the 'phone, because her daughter was post ictal and very confused, so couldn't tell us anything about herself. The cops had taken her mobile phone and called mum to explain what had happened, and to glean more information. I was passed the phone, so that I could get the medical info I needed.

'She has these all the time. She'll be okay soon. She doesn't need to go to hospital', mum told me.

'But she took her anti-epileptic medicine and she still had a fit', I explained.

'Yes, but she'll be fine. She always recovers', mum replied.

'Well, she fell onto a cafe floor this time. If we let her go now, she may have another fit and fall in front of a car.'

I think I persuaded her mum not to pursue the 'she'll be okay' route. The crew took the patient to hospital.

In Oxford Street, a 19 year-old Red Bull drinking girl was hyperventilation and having palpitations. I told the crew we'd deal with it without the need to take her to hospital. She'd declined that anyway and just wanted not to be at work I think. Her colleagues were around and they were very sympathetic, so, after calming her down and reminding her what Red Bull and the likes can do, we left her in the gentle care of her boss.

And a fainting 21 year-old hotel cleaner, who'd been unconscious for a brief time, was taken away for checks by the crew after we'd spent a few minutes finding out that she was doing three jobs a day and not eating well enough to remain standing up. Low-paid foreign workers are suffering in the Capital as they try to make ends meet. They earn enough in reality, thanks to the minimum wage (which you might argue is never enough... but at least it's a start), however, living in or around London is very expensive, and so anything they work hard to earn simply disappears in rent and other costs. No wonder the poor woman was running from one job to another and neglecting herself.

During the weekend of shifts, we had two anaphylactic calls. The first was serious; the man was collapsed at the bottom of the stairs inside a shop. His wife was with him and she explained that he'd come in to buy antihistamine because he'd felt he was reacting to something he'd touched earlier. He'd fallen down and couldn't get back up.

He was covered in a rash and, although his breathing hadn't become compromised, it was clear he was going into Anaphylactic shock. His systems were shutting down. He looked like a man deteriorating there and then. He'd lost bowel control and his vital signs - pulse and blood pressure especially - were out of control.

Naomi is a registered paramedic, so there was no need for her to stand and do nothing. She helped me get started on saving this man's life. A crew had arrived, with another paramedic, so we had more than enough hands and resources to deal with this. If only the shoppers would stop climbing the stairs by walking over us!

We got oxygen on, an anti-histamine and some adrenlanine into him, and very quickly moved him to the ambulance, where we'd stabilise him even more before setting off to hospital. He'd need urgent intervention to bring his BP up. He was still very conscious and quite able to talk to us, but he was clearly frightened.

Naomi has had little experience in giving IM injections, by her own admission, I should add. So I asked her to administer an injection to the patient. She did so and I've never seen anyone jump so much in my life. The patient lurched as if being lanced by a ten-foot pole. Poor Naomi's face... bless.

It was, nevertheless, a job well done by all; a good team effort. A combined Anglo-Welsh effort you could say. The patient arrived at hospital in much better shape than we'd found him and (just so you know) has no objection to this being written.

Our second anaphylactic call was less dramatic. A 17 year-old French visitor began to suffer shortness of breath after eating something she disagreed with. She injected herself with her Anapen auto-injector and her family called an ambulance.

I was a little concerned that they'd chucked the Anapen, with exposed needle, into a litter bin. I asked the family members to go and retrieve it. If someone had pricked their skin with it whilst rummaging around (there are people who do rubbish-rummaging), they'd have been given a nasty little puncture, which may have carried a little Adrenaline into the tissue. Epinephrine causes local tissue necrosis; it's not friendly.

She was fine though. Her Anapen had worked and her breathing was normal, but she still had to go to hospital because Adrenaline doesn't last very long... Histamine does.

There's a sinister looking Santa-type wandering around Trafalgar Square. He has the red suit and the white beard... but he wears orange wellies and he has the complexion of a 1990's Michael Jackson. He is utterly weird to behold and I wouldn't want my little boy seeing him and believing him to be the bringer of presents. I have no doubt his reindeer are parked somewhere but I don't want to see them. Look out for him and send me a pic if you can.

Naomi's comical adventures didn't end with the jumping patient, so I'll share them with you, because they are a lot more entertaining than a list of no-patient-contacts.

A visit to a 52 year-old hostel-dwelling man with abdominal pain, caused by liver damage and Hepatitis, meant she had to ask a simple question or two....

"Do you take pain killers?" She asked.

"Yes, I do", he answered.

"What for?" She continues.

"Pain!" He says, with the exasperated look of a man who is speaking to the Village Idiot.

I had to grin, as did she. We both knew what she meant, but it was funny to hear how it was received.

Then we went to see an 88 year-old man who'd collapsed in a department store. He was very unwell looking; diaphoretic and with suspicious periods of apnoea. We'd already started treatment, wrapped him up and taken him out to the ambulance. The vehicle was parked at a risky angle because the road had been narrowed due to works going on, so we'd asked the workmen to keep an eye on traffic flow and our bags as we continued treatment inside the vehicle.

Just as I was about to get on the ambulance, I saw Naomi trip over the bags and fall, like a lumbering sack of wood, to the ground. It was as though she'd seen them but still wanted to fly over them. This was also witnessed by about five grinning workmen. The poor woman didn't know where to look. Obviously balance and grace aren't taught out in Wales... in London we are all practically Ballerinas!

Maybe I should retract that last comment :-)

Anyway, she recovered, but without the benefit of video evidence (and I wish I'd filmed it), there is no way you can know just how comical it was. She's tough as nails, so she won't mind how I've described it.

The rest of the weekend consisted of more no-show patients and no-contact calls, including the one to Park Lane underpass for an 'unconscious' man. When we got there and went underground to find him, we saw a slumbering street-dweller... inside a sleeping bag. Now, if someone inside a sleeping bag in an underpass in the middle of the day isn't the biggest clue you'll ever get to NOT being dead, then I despair.

He even had a little pool of change lying next to him. Evidently, other, less frantic members of the public who'd passed by had seen it for what it was and thrown a little money at him. Now he has effectively cost you and I hundreds of pounds, just so we can see that he is, in fact..asleep. Oh, and not too happy to be woken up by me.

We ended the tour of duty with a very unwell man with chest pain and a soaring blood pressure. He needed to go to hospital quickly and we made sure that he did.

I've been invited by Naomi's boss to do a few shifts out that way, so that I can experience another way of working. I'm looking forward to it and will report back of course, with all the details. Well, the ones I'm allowed to write about.

All in all, Naomi gave me and my colleagues a laugh at her own expense but she was very well liked and respected. Cheeky banter and humiliating situations often combine in this job to make us what we are. This is a human profession and, regardless of the perspectives of a narrow minority, we really care about what we do. I now know that the Welsh produce paramedics that are just as caring and professionally minded... even if a little brutal with their needles and a little confusing with their questions... and a bit clumsy and blind.

We love you Naomi, you're the best.

Be safe.

Sunday, 6 November 2011


They were filming scenes from the forthcoming updated film version of ‘The Sweeney’ in and around Trafalgar Square today. I know this for two reasons; firstly because, as my breakfast lay beside me in the car, all hot and fresh and lovely looking, I was sent a call that placed me right on top of the location – Trafalgar Square. A drunken male was standing/slumping against one of the statues and security staff couldn’t move him. So I had to let my coffee and breakfast bun get cold, as I attempted to persuade the man to move on. Unfortunately he couldn’t or wouldn’t, so I had to call an ambulance for him. He was so far gone on alcohol that he’d become a statue himself.

The staff on scene told me that a film crew was about to start shooting, and that they wanted him cleared from the Square as soon as possible. I obliged by helping the crew to load him into the ambulance. He was, however, unable/unwilling to help us and he was no lightweight, so he remained on the floor of the ambulance – sleeping soundly and only responding to refuse, by means of pushing and hand-raising, any attempt to help him or take measurements. I’d managed to get a BM, which was lucky, but he was resistant to anything else.

He lay where he lay all the way to hospital and had to be physically ‘spilled’ out onto a chair at the other end.

The other thing that alerted me to the movie shoot was the presence later on of all sorts of actors, lighting and cameras... and a very loud Director who was telling the public, via megaphone, to ‘stay back’ or ‘get out of the way’. The headliner for this movie is Ray Winstone, a great British actor that I have tons of respect for; I remember going to the cinema when I was a teenager and watching him in a movie called ‘Scum’ – a very hard-hitting film about life in a Juvenile Detention Centre. From then, the man’s career has just gone from strength to strength.

A 94 year-old lady with shortness of breath (SOB) sat in a chair in her front room while her carer explained what the problem was and her husband, who was as old as she, undulated in temperament from ranting, repeated confusion to quiet acceptance of his wife’s condition. He had Alzheimer’s and, even though I’d explained that his wife was going to hospital and that her breathing was not good, he still asked what was happening and where she was going.

The crew wrapped her up in oxygen and blankets and he was left with the carer. It was very sad to think that these two would possibly never see each other again.

My pharmacist observer joined me again at this point; she’d had a rubbish shift last time, so now that I was back on air, I thought it only fair to re-invite her today.

In a tourist hotel I met a family from the Lebanon whose 22 year-old son stumbled off a step awkwardly the night before, after a drinking session that surely took control of his ability to feel pain appropriately. Unsurprisingly, he woke up with a very swollen ankle; a sprain for sure, and possibly a fracture, as a result of the twisting missed-step from last night.

His family – dad, mum and sister Beatrice (a lovely and not so well known Lebanese name – I’m kidding; it’s not Lebanese, but you know that, right?), were in the room as I cautioned the young man about drinking too much in future. The difference between a twisted landing from a few steps and a fall onto an underground rail is not so great, as you will know if you are regular reader of this blog.

Anyway, they were very nice people and during the short trip to hospital (ankle boy went with his mum in the ambulance and dad and Beatrice joined me in the car) we chatted about many things, relevant and irrelevant. I don’t often chat to people with any depth unless I know them well and they care enough to listen, but I felt I got on well with the dad to exchange views.

Once in hospital, I bid them all goodbye and I was given permission to mention them here. Beatrice won’t mind at all, unless I’ve spelled her name incorrectly!

Back on the square, the action scenes were being filmed and Mr Winston, et al, were running around with guns that made no sound, except a faint click as they expended plastic shells. The Director helped co-ordinate the sound with the action by shouting ‘bang, bang... running, running... bang, bang, bang!’ Hilarious.

During a break in the proceedings, one of the cast, a 67 year-old female, was brought to me and she explained that, during the running-shooting scene, one of the ‘gunmen’ had fallen on top of her on the stairs. She was an extra and he was one of the actors. Apparently, he weighed a bit, and so the collision had caused her neck and shoulder pain, which she went to extraordinary lengths to remind me about... she continued her medical history with the crew when they arrived to take over.

She was also very concerned about what her Supervisor would say... she wanted her personal belongings brought to her and she had to sign something if she couldn’t continue with the day, so I agreed to sort this out for her.

Meanwhile, a knock on the ambulance door alerted us to a new patient. He was vomiting blood on the pavement outside; behind the ambulance in fact. It was all getting a bit dramatic on Trafalgar Square!

The man vomiting blood had a genetic condition that caused this, among other things, to occur and he was reasonably stable when I checked him out. I asked for another ambulance, and when the crew saw the man, they recognised him and knew of his problems. This helped speed up the delivery process, so I could get on with finding the actresses personal bits and pieces.

I hunted her Supervisor down in a restaurant, not far from the square, and I explained what had happened to her. I asked for her personal belongings (I’d been given a list) and it became a bit of a treasure hunt. There were lots of acting types eating and drinking in the place, and the neck/shoulder patient’s stuff was somewhere among them all. I had to follow descriptions written on her notes so that I could locate everything she owned. It took a few tries (how many bags with black checks could there be in one place?), but I eventually solved the clues.

With Control’s permission, we trundled to the hospital where the lady had been taken, and gave her what she owned.

After a short interval, during which we were able to watch a little more of the movie being shot in the square, I was called to an elderly doctor in a very posh building. He was having difficulty breathing. As we entered the building, a woman told us to go up to the fourth floor. A lift took us up to a bedroom and there, on the bed, was the patient. He was in trouble. His breathing was very poor and his lungs rattled with fluid – even without a stethoscope it was audible. His sats were 80% on air and I gave him a little oxygen to boost it.

The retired doctor had chronic lung disease and was clearly dying. The woman downstairs was his wife and the entire building was their home. Nobody else lived with them. It was eerie to walk down the stairs after the crew had arrived to take the patient away (they’d need the lift); every floor was in darkness and clearly unused, but there was evidence of a past life in each shadow-filled room... evidence of a healthier, younger couple who’d occupied all of the house, instead of the small parts they now moved between using the lift.

Off to the London Aquarium next for a 3 year-old ‘coughing up blood’. This is normally not the case and all that usually happens is a little of the red stuff comes out after a particularly exertive coughing session that is violent enough to tear the small blood vessels in the throat. I wasn’t anticipating a catastrophe to be honest, and when we arrived it took a while to locate the exact spot I’d been given.

When we got to the restaurant, there was no sign of a child, mother or blood to support the call. But as we left, a woman told me that the mother had literally just gone with the little boy. She was making her own way across the road to hospital. She also told me that the child had coughed after eating and a large pool of blood had come from his mouth. This was not the description I expected and so I was relieved that mum and child had gone because it is actually a longer trip by vehicle than it is on foot in that particular place.

The shift ended with the alleged beating up of a 16 year-old school girl by a gang of Travellers who’d entered the fast food restaurant she and her friends were in. According to the young girl, one of them had tripped over her foot and turned on her as if she’d stuck it out deliberately. The gang surrounded her and she got a couple of punches to the face, just for being there. The assault was allegedly carried out by a 14 year-old boy.

I met her and her friends... and her teacher, at a police station, where they were recording the incident. The culprits may never be caught, but this young French visitor will probably never trust this City again. Her nose looked broken but she’d need an xray to confirm that.

Be safe.

Saturday, 5 November 2011

Invisible paramedic

I had a few observers out with me on the latest run of shifts; a pharmacist from St Thomas’ Hospital, a medical student from UAE and a paramedic from the Welsh Ambulance Service.

Computerising a system is all well and good but a human eye or two is much more valuable when you are running an emergency service I think. I spent an entire shift out in my area, listening to sirens around me and wondering why I was being ignored. It was obviously busy but I hadn’t been given a single incident to deal with.

By the end of my shift I had begun to seriously doubt my normally cynical view of how we are an over-used and abused service. I had checked in and made myself available. I had given my call-sign and status at the start of the shift. If I wasn’t getting any calls, it was because there were more than enough resources already out there I figured.

This was the pharmacists shift and she wasn’t impressed at the lack of work we do out here!

When I called in to end my shift I was told that, although they’d known I was out there, the computer did not. My call-sign wasn’t registered with the system, so it was completely blind to me and calls were being routed to everyone else around me instead. This was the first shift I’ve experienced on the FRU where I did absolutely nothing all day long.

My next shift was Faye’s, the UAE doctor-to-be, and it was a little more useful to the London public. I was using an old call-sign and calls were sent, as usual, in my direction.

The first call was to a 97 year-old lady who was having difficulty in breathing. When I arrived her carer told me she’d been fine until the moment she was leaving; that’s when the old lady began to complain of breathing problems. In fact, she was having a panic attack and was hyperventilating. She was known to suffer from such attacks. She lived alone and her only contact with the outside world, apart from a visit to her church when she could, was her carer.

I spoke to her as she sobbed and I tried to calm her down. She was lonely and desperate for company and a change of environment. She was stuck on the fourth floor of a council block. She couldn’t use the lift, even though she was mobile, because it scared her (she’d been trapped in it when it broke down in the past), so she tended to use the stairs when she went to church. This is a major challenge for such a frail little old lady. Maybe Councils should consider where they put the elderly when it comes to accommodating them.

I left her in the safe hands of the crew, after chatting to her and holding her hand until she’d calmed down.

Soon after this, I was off to see a 30 year-old man who was fitting in the street. There were major demonstrations taking place in Central London, so things were getting tight, in terms of getting to and from places. This man, a street-dweller, was close to where everything was kicking off. As a result, after I’d carried out basic obs and got him into the car, a demo of about 200 people streamed past me. The police cordoned me into the pavement and the ambulance I had requested was stuck at the end of the slow-moving procession. It seemed ridiculous; although this patient was stable enough (he was shaking in the ‘I might have a fit’ fashion but it was mostly under his own control), if he’d gone into cardiac arrest I would have been hard pushed to get reinforcements to me in time.

When I asked the man about his medical history, he revealed that he’d been suffering seizures for a long time and that the doctors hadn’t diagnosed anything yet. He also told me they’d taken all his meds away from him on his last stay at hospital. This made me think. Although he did attempt a few tremorous warnings that he may fit again, it never looked likely to me. He always looked well enough in control of himself and Faye told me that when I looked away, he stopped shaking.

Eventually, the ambulance got through and I got him off to hospital. Central London was being cordoned off at Whitehall and The Mall, so I was about to become trapped inside a smallish footprint area.

But I was sent North and away from the protesters for a short while, as I searched for an elusive hospital-gowned angry woman who was, according to the caller, shouting abuse and being aggressive. I drove around the area a few times but couldn’t spot her; she either never existed, or had gone underground (quite literally)... or had wandered back to hospital to have her gown changed.

The police arrived on scene but, after a search of the park, they had similar luck. One of the officers is a friend of mine (that’s what you call a cop you’ve bumped into on dozens of jobs through the years) and we spent ten minutes jawing about this and that before calling it a day on the great search and rescue expedition dubbed the ‘phantom ranter’.

A few hours went by and I watched the demonstrations become larger and more central. This made the police very nervous and so, acting on intelligence I guess, they used their vans to completely block off the entrances to the important streets. It looked as if they were expecting a full scale riot. Instead, we got treated to an antique car rally that wound itself through the streets towards Piccadilly, the area of my next (and last) call of the shift. A 35 year-old woman was reportedly ‘collapsed’ and unconscious in a five star Hotel.

I’m afraid that when I get a report like that, the cynic in me comes out because over the years I can count on one hand the number of calls, described just like this, that actually turn out to be as given. Usually, there is a perfectly conscious person at the end of the trip. Conscious, breathing and laying on the floor waiting to be rescued for something that is nothing to do with the initial 999 request.

So, down into the bowels of the hotel we went... down until we reached the staff areas, where things are a little less than five star. The staff member showing me to the patient seemed surprised that she wasn’t where he’d left her. He was told that she’d ‘moved somewhere else’. This, of course, is a major feat for an unconscious person – Jesus being the only known historical exception to the rule of unconscious/dead equals’ inanimacy (I’m not entirely sure of this word but it sounds right).

When I was guided round to where she was, I found her lying on the floor, on her side and not willing to acknowledge me. She was conscious because her eyelids were flapping a bit and when I referred to her by name, she practically sat up... although she didn’t.

Now I don’t really mind if people want to display their emotional distress at feeling unwell by dramatically dropping to the floor, thus scaring the pants off those around them, who may think they’ve just witnessed a death, but there are people in real trouble out there and they really need an ambulance. I’d much rather be paying attention to them.

So I managed to get her to open her eyes and tell me what the problem was. She had a stomach ache. That was it. Painful as it may have been to her, it didn’t necessitate a Red emergency response.

The crew arrived within a few minutes and, as I watched in my rear-view mirror, she walked out with them, supported by a staff member. As I referred back to my paperwork, a strange and almost surreal thing caught my eye. I saw a man pushing an antique car up the hill towards Piccadilly. I think the vehicle was person-powered because the running man seemed to be comfortable doing what he was doing – pushing a car with someone sitting in it. I suddenly felt the urge to shout out ‘What’s the point? Why don’t you both just jog?’ But I didn’t.

On the way back to base, we passed another one of these old vehicles. It had broken down and the men driving it were frantically trying to get it started again. They weren’t cranking a handle and they weren’t push-starting a motor... they were setting fire to its underbelly in order to get a boiler heated so that steam could power it up the hill! Flames were belching out from below and tourists were stopping to film and photograph the sight.

I don’t care what they say about London in some places; this is one of the funniest cities in the world.

Be safe.